!!Comatoa$ted

I have been studying diabetes mellitus lately and have a pretty good understanding of it so far. There is one thing that I am curious about and I wonder if I could get some help with this?

In the absence of carbs the body breaks down fats and protein for fuel. Part of the fuel that is used is ketones. In the case of ketoacidosis in a diabetic the body is not using the glucose available in the blood, so the body produces more glucose, as well as ketones from fatty acid oxidation. The ketones as well as the glucose can’t be used, so the pH of the blood is lowered because of the ketones. Normally when the body uses ketones for fuel it regenerates bi-carb, thus restoring the acid-base balance.

Even though ketones may not stimulate insulin secretion, is insulin still needed by cells to absorb ketones so ketones can be used as an energy source? From what I have read I think yes, but this was inferred and not stated outright.

jimisnowhere

Now I'm not especially sure. Nut I thought ketones in the system is a sign of astronomical blood sugar levels. My dad's meter says "Check Ketones" when his sugar (used to, but doesn't anymore) broke the 500 or 600 mark. I also read in my mom's old school books that they are from proteins decomposing in the blood stream. It said someone suffering from this would smell like old yogurt or soured bread dough, and needs to call a doctor.

I don't think I answered your question, but this may be something else to look into


jim

slowandsteady

You are refering to ketoacidosis.

TryingMyBest

I think you are asking is the mechanism of transport of ketones into cells dependent on insulin. I have no reason to believe it is, but that's something I was never taught so who knows. It can probably be filed under who cares (ie, no clinical application).

DannoXYZ 

Think about where these ketones are formed... and their precursors... there's your answer...

NoRacer

Check it out:

https://en.wikipedia.org/wiki/Lipid_metabolism

But, with diabetes, some of the mechanism are impaired due the disease.

ModoVincere

I do not know the answer to your question !!Comatoa$ted. I can speculate though. Ketoacidosis is caused by an excess of ketones in the system. I believe the ketones can pass through the cell membrane without insulin present, but in a diabetic who is in ketoacidosis, the production of ketones far outpaces the cellular usage of the ketones. Thus the ketones build up in the blood. I believe the primary ketones that build up are acetoacetat, beta-hydroxybutyrate, and acetone. It is the acetone which gives the diabetic the characteristic "fruity" smell to the breath, as acetone is highly volatile and exits through the lungs.

!!Comatoa$ted

Yeah I understand what you are saying. Though under normal conditions when cells use ketones for energy a by-product is bi-carbonate. From what I understand and according to Randin and Nakoto (2004) in McCance and Huether (2006) “Because of over production of α-hydroxybutyrate and acetoacetic acids causes increased ketone concentrations. Ordinarily, ketones are used by tissue as an energy source regenerates bicarbonate, which occurs when the ketone is formed. Hyperketonemia may be a result of impairment in the use of ketones by peripheral tissue, which permits strong organic acids to circulate freely. Bicarbonate buffering then does not occur, and the individual develops metabolic acidosis.”

ModoVincere

https://www.pubmedcentral.nih.gov/art...i?artid=291994

The above link would indicate that, in dogs at least, insulin does indeed effect the transport of ketones. The ketones were crossing the cell walls without insulin, but insulin speeds the process up.

!!Comatoa$ted

Thank you very much for showing me this, it is much apprieciated. As for the experiment being done on dogs, I think that it may be accurate because Banting and Best made many of thier discoveries on insulin using dogs. As well, up until recently pork and beef insulin was used, and this was before human insulin was made by recombination.

TryingMyBest

!!Comatoa$ted, I'm just curious and hope you don't mind me asking: Why are you asking this in the first place? What's the significance?

!!Comatoa$ted

No I don't mind you asking, your curiosity is a compliment.

I am studying diabetes, and I take care of many people who have diabetes. Diabetes can affect every body system and I believe that in the near future most morbidities will be a direct result of diabetes. I also wish to work with the native population, and every native person that I have had the privilege of working with has diabetes. Four out of five of my classes over the past few weeks have had a focus on diabetes. I feel to be able to handle the care aspect of diabetes I need to understand as many aspects as possible.

Ketosis and ketoacidosis have been a subject of interest to me. I know that for what I will be doing in the next few years will not need the knowledge of the exact mechanisms of how the body uses ketones and the like. I am very curious about biological functions and the more intimately I know one function the more I will know about all the others, since none function in isolation. Also being a student I spend about 8 hours a day reading so naturally I will read just about anything that does not have a plot and has to do with biology, and I am very curious.

As well, I have a goal to get my PhD in biology by the age of 60; and hope to spend my time studying peripheral neuropathies, especially Charcot-Marie-Tooth disease, which coincidentally has many of the symptoms of someone with uncontrolled diabetes. Plus if one can understand diabetes and how it effects the body you will have a greater understanding of the body as a whole, and more importantly, how it affects the individual who is the most important part of the body.

But now I must get back to reading about ethics, my fifth class, which would be more interesting if the 10 or so readings did not regurgitate the same stuff in each reading.

TryingMyBest

A PhD, sounds good! You're asking the right questions a PhD would ask. Have fun with the ethics class. It's probably one of the more straight forward classes.

hyunelan2

Ketoacidosis almost killed me about 7 years ago (I've been a type-1 diabetic for almost 8 years). I don't know the exact cellular biology, but Lehman's terms = high blood sugar, for extended period of time = body burning fats for energy = acidic blood = bad.

Since then, I've done some growing up (mentally) and am in good diabetic health. Back when I was 19, I still had the "I'm invincible this diabetes thing will go away if I ignore it hard enough" attitude. I was away from my dorm, didn't go back to take my insulin, and almost died the following morning. Collapsed in the hallway, was taken by ambulance while fading in and out of consciousness, and spent some time in intensive care. I had to watch the superbowl in ICU that year... not exactly a party.

I also hold the 'unoffical record' at a local hospital for the highest blood-sugar level by a conscious person. That was a year earlier when I was first diagnosed and admitted for treatment.

Enthalpic

Research alcoholism or obesity. “Quit mopping up the water and turn off the tap.”

!!Comatoa$ted

Well I still have a lot to learn, and I still have 26 years of education left. The main problem that I have is that sometimes I think that I know a lot, once I get over that I will really start to learn.


Thank you for sharing your story with us. I am glad to hear that you are experiencing good health.

The funny thing about your story, if near death experiences can be funny, is that we have had many case studies that deal with diabetes that sound almost exactly like your experience. The sad thing is that the more doctors, nurses and the like think they know about diabetes care, the more they are wrong. The real experts are the people who are living with the disease and continue to thrive. Many treat thier chronicity much different than thier doctor or nurse has told them too and live nearly symptom free. This goes to show that the individual variation is much different than most quantitative studies would like to suggest.

Medicine and nursing like to think that by looking at the population as a whole they can best dictate how to live with a chronicity, when from my complete lack of knowledge and experience it seems that the individual has the best answer, and not the professional.

!!Comatoa$ted

In the end it is CMT I want to research, and that is many years away. Who knows I still have a lot to do before I can get there, and things may change by that time.

TryingMyBest

Holy crap, 26 years?! What are you studying?


I'm intrigued. What do the doctors have wrong and what are the diabetics doing that provide more benefits than what their doctors are telling them?

hyunelan2

I think what he means is that regardless what the medical professionals tell a patient about how to live their life, diabetics are going to live in a way that makes them the 'happiest' with everyday life. If that means ignoring some doctors orders, it's going to happen. I am lucky that my doctor is very understanding of this in his treatment recommendations. I'm pretty smart about what certain foods do to my body, how much insulin (or exercise) needs to be take to counteract them, etc. During cycling season for example, I take less insulin -often taking none at nightime- because I'm getting good exercise every day. Some medical professionals would see that and say "you will exercise every day." That sounds reasonable from a medical standpoint - but in reality sometimes it just doesn't happen (especially during Chicago winters). On those days, I have the needle for the extra dose to put me to normal.


[now wandering on an slightly off topic monologue]
I have what they call "walking diabetes" in that my levels can surge above 300, and never slow me down. I'll feel symptoms after a few hours of being that high, but it's not imobilizing to me like some people experience. I can usually guess -within vegas odds- what my blood-sugar level is at any time, whether it's high, low, or normal (don't worry, I still use gluclose testers regularly). Still, IMO the best advancement they could develop for diabetics would be a real-time monitor. I'd love to wear a wristwatch type device and be able to just glance at it to see where I'm at. It would be sooo helpful to many diabetics. ESPECIALLY WHEN RIDING. I always worry about my sugar going too low (which has a higher acute danger than too high) and sometimes over-eat while riding.

If anyone wants to know anything else about my experiences with diabetes, feel free to ask. I don't mind sharing at all. [/end]

!!Comatoa$ted

I paln to finish my undergrad, then I have to work for 2 years before I can start on my masters part time, that will take about 7 years. Then I need to use that degree for a while before I can start on my PhD, so it could be almost 20 years before I even get to start on my PhD education. Meanwhile I intend to keep learning as I work so I can have more than just theoretical experience.

Sorry, I worded that wrong. I don't think nurses and doctors have it wrong. They are important in the education of the individual, but IMO, people are individuals; and although one way may be good it is the individual who has to figure out what works best for them, and still continue to be an individual who can take responsibility for their condition. Most people that have lived with their disease or chronicity for many years successfully, will know so much more than a health care professional will about how the disease affects the individual. For some people living like HCP's want one to is impossible and can make their situation worse. There are so many other factors to consider, like culture. It is up to the individual and the HCP to work together and find the best way to deal with the situation, and not have the HCP indicate that the person is non-compliant. The person may not understand, care or be able to possibly follow a regimen set out for them without consideration to their lifestyle, and culture.

slowandsteady

Holy cow! Most places will not even let you take 7 years to get your masters. I did mine part time in 3 years...and I thought that was slow. Another girl where I work just got hers in 3 years also. I also don't know what you mean by using your degree. You don't even need to get a masters to get a PhD. Cut out the middle man. Or get the masters and apply those credits towards the PhD which is 90% research anyway.

!!Comatoa$ted

Athabaska college will let me get my masters in 7 years through correspondance. I want to get my NP after I complete my undergrad and work in remote northern communities, but before that I need to have over 4000 hrs of practice before I can even apply for my masters.

I don't mind taking the slow route, I want to have a very intimate knowledge what I am doing, plus I want to do as many things as I can and acquire as much knowledge in different fields as I can in my life. And if herdity is true to me I will still have another 40-50 years of life left after I turn 60.

I am a bit curious about you. From what I have gleaned from previous posts you work in the phamecutical industry, I am curious about you educational background, are you a pharmacists of pharm researcher?

slowandsteady

Ah...correspondance school, that explains the need to use the degree. If I can give you a bit of advice. There is no substitute for doing one's own research or attending labs.

I am a biologist and work developing in vivo models of disease to test the efficacy of biotech drugs such as monoclonal antibodies. I have a varied background in metabolic disorders, osteoarthritis, infectious disease, pharmacokinetics, transgenic rodents, and gene vaccines for cancer. I also have an MBA in technology management and am pursuing my PhD in biochemisty.

I think it is wonderful to continue one's education. I have been in school forever. After I retire, I will attend community college classes for welding, auto mechanics, and autobody. I hate when I don't know how to do something.

!!Comatoa$ted

Thats awesome, you are doing something similar to what I would like to do one day exept I hope to focus on genetic diseases. I guess there is probably a huge difference when you are looking to have something with such a tight focus. Ohh well so much to learn. As for the boichem part that you mention, I am jelous.

I am still trying to wrap my head around monoclonal antibodies. It is very interesting to see how much auto-immune diseases contribute to diabetes, as well as so many others. The more I learn the less I know.

My clinical instructors are always telling us that the most versatile degree you can get is an MBA, I think she called it the passe partout (master key).

I wish you the best of luck in you studies.